Saturday, December 5, 2009

They're BAAAACK!

I’ve been a reader of The Happy Medic and Medic 999 for a long time now. I mentioned in an earlier post that it was partly because of their blogs that I decided to give this a try. So you won’t be amazed to learn that I have been missing them during their well deserved rest period. This morning, during the 6 spare minutes I have before leaving for work I was contemplating doing a “You Make The Call” piece to fill in for Justin.
That is a moot point now, and in addition to coming back ‘on the air’ Justin had broken the break with a piece about his trip AND a “You Make The Call” piece. Mark has also come back with some very nice writing and it whets my lips for the coming few weeks of posts from both “Johnny and Roy” as I like to call them. Mark, if you don’t ‘get’ this reference, ask Justin. It’s a compliment.
Their posts are a welcome relief for me, because I was driving to work and trying to pick a call out of my memory and figure out how to put it into words. It wasn't going well in my head and I knew it would look worse on the screen.
So I'll jut tell you about my routine day instead.
Once I got to work, the job overtook my thoughts and although I can usually steal a little ‘think time’ for myself near the end of the day, today that was not to happen. I was interrupted by a cardiac call for one of my co-workers. Volunteers are always on duty, right? I was in a meeting when they were trying to find me, finally they called the conference room and I knew it was an internal call so I answered the call (which interrupted the meeting flow) with something humorous like “Crisis Management Office, how may I direct your crisis please?” It was an HR person and she said: We NEED you out in George’s area right now” I said “OK, tell me what’s going on” so she started to give me a long litany of symptoms “Well he’s sweating like mad and can’t breath and he’s really tired and he says…”, “OK, I cut her off, I get the picture, I’m on my way.” I only asked her because ‘needing me there NOW’ doesn’t tell me what I will be dealing with and what gear I might need. I have been called with the same urgency to a minor finger laceration.
I am the only person in the building with any training beyond ‘first aid/CPR’ and we run a very safe company. We are anal about safety and I can tell you that a year with 3 finger cuts is a really bad year. I kid you not. It is not a place where an EMT would go to practice his skills. So getting this call was something I expected to get someday, but certainly not something that is common.
So out I go and grab the trauma bag out of the First Aid room on the way. “Hey George, tell me what’s going on man” I asked as I approached. George is almost 60 and a former Police Officer and EMT. He knows the drill and we communicate on a level that nobody in the surrounding group even comprehends, which is fine for both of us. It leaves them out of the conversation even as they are listening to everything we say. “OK George, any diff breathing?”, “yup, bigtime” he says. “Hows the lungs?” I ask. “Probably clear in all fields, no sounds that I can feel, but give a listen anyway”. I wrap the cuff on his bulky arm while I yank the cheapo steth out of the company trauma bag and also turn over my shoulder and throw my car keys to the HR manager and ask her to go to my truck, grab the ‘big red bag and the round green bag behind the driver’s seat and get them in here’. I get the cuff pumped up to around 100 and check for pulse sounds….nothing. I reposition the arm, tell him to relax and search for the magic BUMP-BUMP-BUMP. Nothing. I can’t find the artery. Damn cheap stethoscopes. OK fine, what next. Well I think, I need a pulse to see how hard he’s working because I already see short rapid respirations. Feeling for a pulse, but this guy has thick wrists and again I’m having trouble. My O2 shows up, well hell, I know that no matter what’s going on here the O2 is going to fit into the hit parade of treatments, so lets get it going. Then I realize I screwed up. I always like to know what the O2 sats are prior to administering the O2. It tells me how the patient was doing prior to treatment and if the treatment helped. But I don’t have my pulse ox, it’s out in the truck in my little holster right next to my Littmann Stethescope. I send the HR manager back out for it. (I always knew that these managers were good for something!) I go through all the questions on meds, blood sugar, recent history and George spills it all out like a pro, he knows what his sugar was at 7am this morning and again at an hour ago, he tells me how it tracks with his normal history. He doesn’t spell it out for me, he knows I am putting it all together. His sugar level is 224, but that doesn’t quite wash with his other symptoms and George came to that conclusion 10 minutes before I did, that he had a cardiac issue. He never told me that, he knew I’d reach my own conclusions. The pulse ox shows up and George is feeling better with the O2. I’ve made another attempt at the B/P with my own cuff and steth, still no joy. Fire shows up, an engine with 2 EMT’s. They have no monitor, which is all I want to get on my patient at this point. They start taking a history and I am happy to let others work on that while I continue to think this through. The one EMT takes a shot at the B/P and has no luck either. I have been giving directions to others while this is going on as to where to bring in the ambulance (we bring it right in the building) and I sent somebody to meet the rig and tell them to come in with a stretcher and a monitor. They brought the monitor but the driver went back for the stretcher. The medic was not only somebody I knew, but a neighbor from down my road. “Hey Bill” I said in my usual ‘on-scene, everything is under control’ voice. “This is my friend George, George had a sudden onset of difficulty breathing and is diaphoretic. He says he has no specific chest pain, but I am seeing that his respirations are about 30 and shallow, I had no luck getting a B/P due to my poor ears, sorry, but his O2 sats are now 98 percent on 15 liters and the NRB and his pulse is holding around 76 but weak. I’d really like to get a monitor on George to see if we can identify what is going on.”. Bill went into his deal and I shut up and changed to support mode. Bill had a new partner I have not yet met and I could tell by some of the basic questions about ‘what do you want, and where do you keep it’ that they were new at working together. Hell I had only worked 3 calls with Bill in the past 2 years and I knew the answers. So I played support guy and anticipated what he would want to do and what he would need so that I could try to get ahead of him and have what he wanted ready when he asked for it falling easily into the routine I have done a thousand times when we run a call that is properly deemed as ALS. We packed the patient and got him in the rig about the time the O2 in my bottle ran out and we switched bottles and I got mine back. I was closing the doors on the back of the rig and just asked the Medic one last time if there was anything else he needed (his EMT had just asked for the third time which hospital they were going to), and he looked up and said, “Yeah, call my Father-in-law and tell him that you’ve managed to work a call with me before he did.” Small Towns, you gotta love them. Bill has been a medic for about 2 years now, and he was a career EMT before that, but lost his way in his paramedic classes. 2 Years ago, he married the daughter of a member in my volley squad, and with kids on the way, started to see a bigger picture and had no problem finishing his classes and clinical time. I guess he has yet to work a call with his father-in-law.
Monday, things will be normal at work but I will be requesting an informal meeting to do a call review and see if we can streamline the way we do things. When people don’t see what can happen and understand that having a plan is important, they avoid it. I have been telling them for 3 years that this incident would happen and they all blew me off. Now it has happened and they have an opportunity to make things a little safer for those involved, including the patient. For me it’s just another cardiac call, routine stuff, for them it should be a wake up call. Do you think that maybe perhaps, I can finally get an O2 bottle in the building?

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